VII. the Therapy of Diabetic Ketoacidosis

THE many changes that result from the deficiency of insulin affect all aspects of intermediary metabolism. Without the regulatory action of insulin peripheral underutilization and hepatic overproduction of glucose result in severe hyperglycemia, with a subsequent osmotic diuresis, dehydration and substantial depletion of electrolytes. Concomitantly, profound protein catabolism accounts for drastic nitrogen loss as well as an enhanced amino acid pool from which heightened gluconeogenesis proceeds. Without the restraint on lipolysis afforded by insulin, adipose stores are drastically reduced, resulting in elevated plasma levels of glycerol and free fatty acids. Oxidation of the latter substrate expands the hepatic pool of . . .